Motivational Anhedonia And Individualized Accurate Target Positioning RTMS Treatment On Depressive Disorder

Objective:Depressive Disorder is a pervasive and burdensome mental illness that imposes a heavy burden on individuals and society.Among them,motivational anhedonia is the core symptom of depression,but its mechanism is not clear,and lack of targeted treatment.This study takes the motivational anhedonia of depression as the entry point,from the assessment of motivational anhedonia in depression,to examine the reliability and validity of the Self-Report Apathy Evaluation Scale,and motivational anhedonia was compared between normal and depressed populations using event-related potentials,using repetitive transcranial magnetic stimulation,the left DLPFC with positive sexual connection with NAcc was selected as the target.Patients with depression were treated with 10 Hz excitatory rTMS to explore the motivational anhedonia of depression.Methods:Method 1.A sample of 397 students completed the revised scale.The criteria were the Beck Depression Self-Rating Scale,Self-Rating Depression Scale,Snaithe-Hamilton Pleasure Scale,The Temporal Experience of Pleasure Scale.Method 2.Using AES-S and TEPS,28 depressed patients with high motivational anhedonia were selected,and the event-related potential technique was used to conduct a study on 28 depressed patients and 28 healthy control group using money delayed reward task.Method 3.rTMS was used to treat 24 patients with depression for 15 consecutive days with 10hz-rTMS stimulation of left DLPFC,in which 13 patients received activestimulation and 11 received sham stimulation.Results:Results 1.The item analysis indicated good homogeneity and discrimination of the items.The scales had high internal consistency(r=0.89),and retest reliability after four weeks(r=0.91,n=145).The fit indices of the four factors structure of the revised scale were good.The total score of AES-S were positively associated with that of BDI?SDS?SHAPS?TEPS and its subscales in the total sample.Results 2.Monetary Incentive Delay Task results were shown:for Cue-P3 peak latencies,in depressed patients was delayed compared with that in healthy controls,but did not reach a significant level.In terms of the CNV amplitude difference induced by different rewards of RMB 3 and RMB 1.5,the patients with depression were significantly smaller than the healthy control group.For FRN mean amplitudes,the main effect of group was failed significant.Cue-P3 amplitude was significantly correlated with depression symptom scale(BDI,HAMD)and motivational anhedonia scale(TEPS-ant)scores;CNV amplitude was significantly correlated with depression symptom scale(BDI)and motivational anhedonia scale(TEPS-ant)scores;FRN amplitude induced by feedback stimulus was significantly correlated with the score of motivational anhedonia scale(TEPS-con).Results 3.After 15 days of 10 Hz rTMS treatment,The scores of depression symptom scale(BDI,HAMD)and motivational anhedonia score scale(TEPS,AES-S)in the active group were significantly decreased,on the depression symptom scale and the motivational anhedonia scale,the scores of the sham group did not decrease significantly.Conclusion: The Self-Report Apathy Evaluation Scale—Chinese Version is a reliable and valid instrument,and can be used to measure the level of motivational anhedonia.Depression do have motivational anhedonia,compared with normal people,there aredifferences in reward stimulation and reward expectation,and the severity of motivational anhedonia is related to depressive symptoms.Stimulation of left DLPFC by 10hz-rtms can improve depression symptoms and motivational anhedonia in patients with depression.